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Arizona rates for HCPCS L1110

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, ring flange, plastic or leather, molded to patient model

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $173.78 / $676.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $213.80 / $446.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $354.81 / $676.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $223.87 / $223.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $223.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.33 / $257.04 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $144.54 / $2,089.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $190.55 / $309.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $144.54 / $213.80